Self-Insured Non-Federal Governmental Plans (NQTL analysis)

Non-Quantitative Treatment Limitation Analyses and Compliance Under MHPAEA (CMS-10773)

OMB: 0938-1393

IC ID: 246609

Documents and Forms
Document Name
Document Type
Other-Guidance
Other-Guidance
Information Collection (IC) Details

View Information Collection (IC)

Self-Insured Non-Federal Governmental Plans (NQTL analysis)
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Guidance CMS-10773 Appendix I - FAQs-Part-45.docx Yes No Paper Only

Health Health Care Services

 

34,879 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 34,879 0 0 0 0 34,879
Annual IC Time Burden (Hours) 930,107 0 0 0 0 930,107
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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